Provider Demographics
NPI:1194496000
Name:SEFA, KWESI A (PHARMD)
Entity type:Individual
Prefix:
First Name:KWESI
Middle Name:A
Last Name:SEFA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8804 TEMPLE HILL RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-2454
Mailing Address - Country:US
Mailing Address - Phone:240-413-5323
Mailing Address - Fax:
Practice Address - Street 1:1521-1523 NORTH QUAKER LANE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302
Practice Address - Country:US
Practice Address - Phone:703-998-6560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202219922183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist